Note: Descriptions are shown in the official language in which they were submitted.
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This invention relates to apparatus and method for providing
and administering at least one of visual and auditory tests to
observers to assess at least one of their visual, auditory,
cognitive and attentional performance capability.
Humans are able to process information about their
environment through the senses of vision an~ hearing. Although
vision and hearing senses are concerned with transduction of
; variations in photic and acoustic energy radiated or reflected
from surrounding objects into nervous impulses, they also include
the neural mechanisms used in the coding, transmission, storage
and association of sensory signals within the nervous system.
Important in every aspect of life and strongly represented in the
experiences, descriptions and concerns o the individual, vision
and auditory functions receive much attention in health care
services.
Abnormalities of visual, auditory, cognitive and attentional
function can indicate the presence of a variety of diseases and
disorders. As a considerable portion of the human brain is
devoted to vision and hearing, and as the neural mechanisms
mediating vision and hearing are distributed throughout the
brain, disorders that afect brain structure and function will
often affect vision and/or hearing function either directly or
indirectly. Conse~uently, information regarding visual and
auditory function is useful to the medical diagnostician.
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The visual and auditory sensory modalities are efficient
information channels and are, -therefore, also an important means
for providing input for the evaluation of certain aspects of
cognition and attentional capabilities. Rapid and noninvasive
î evaluation of visual, auditory, cognitive and attentional
performance are also desirable in many non-medical applications,
for example, in the screening of individuals who may be either
especially well suited or especially poorly suited for tasks
requiring a given degree of visual, auditory, cognitive or
attentional capacity. As these capacities are known to change
with changes in the level of fatigue, arousal and the number of
other tasks requir~d of the subject at the same time, it is
important to be able to evaluate these capabilities under
conditions where these variables are controlled.
Automation of visual, auditory, cognitive and attentional
tests can greatly increase the efficiency of test administration
through increasing test speed, patient comfort and data quality.
Test automation also oEfers the promise of decreased cost,
including savings in operational time and space requirements.
Two basis types of tests are used: psychophysical tests
(where behavioral responses are obtained), and stimulus-evoked
electrophysiological tests (where electrical responses from the
brain are recorded that are believed to reflect specific sensory,
cognitive or attentional capabilities). Phychophysical tests
have the advantages o~ relative technical simplicity, non-
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invasiveness and accuracy. Some of the most venerable
diagnostica]ly useful tests are psychophysical tests of sensory
function. Among these are the determination of visual activity,
colour vision, parametric analysis of visual fields, dark
adaptation; of determining auditory function, including absolute
and di ferential audiometry, masking speech recognition and
localization. Many of these tests have shown to be of use in
following the progression and remission of diseases as well as in
estimating the amount of residual function after cerebrovascular
accidents and trauma. They can also be used to provide objective
evaluation of therapeutic interventions,e.g. drug treatments,
etc. ~here are three areas of application of stimulus-evoked
electrophysiological techniques that complement psychophysical
methods, namely: (1) as an index of sensory processes not
amenable to study through psychoph~sical means; (~) for more
objective confirmation of psychophysical findings in patients who
are, for whatever reason, difficult to test; and (3) for real-
time monitoring of sensory status during surgery and therapy.
Although the past decade has shown the emergence of many
devices for the analysis of electrical responses from the brain
(and which concentrate mainly, upon the signal processing aspects
of the recording technique), few automatic methods have been
~` deveIoped that generate stimuli, control stimulus presentation,
collect subject responses and store and manage the data obtained.
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Canadian Patent No. 1,17~,359 of Ledley et al, issued
September 11, 1984, describes an apparatus or a computerized
electro-oculo~raphic system for automatic administration of
electro-oculographic tests and visual evoked response tests to a
patient, and automated processing of results derived from such
tests. Automated administration of the tests is conducted either
under the direct control of the test administrator via an
operator control section or under the automated control of a
programmed computer with indirect control by the test
~lO administrator. It should be noted that such apparatus, although
providing automated administration of certain test stimuli to a
patient via employment of an operator control console, does not
have multi-purpose capability. It does not provide
t- intelligence" in the system so as to allow optimization of the
tests based on operator selection test batteries. Furthermore,
it does not provide comparison capability of test results with
normati~e data from a database.
herefore, it is an object of one broad aspect of the
present invention to provide an automated multi-purpose, real-
tlme base apparatus for test administration and or recording
analysis of data in real-time, which also is capable of providing
means to enable the test administrator to optimize test
batteries.
Accordingly, by one broad aspect of the present i~vention,
an interactive patient diagnostic system of the stimulus-response
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type is provided herein for evaluating aspects of at least one of
visual, auditory, cognitive, and attentional performance and
capacity of a subject, comprising: (a) a h~st computer; (b) a
stimulus generator display means for presenting predetermined
sequential input stimuli including at least one of visual stimuli
and audi-tory stimuli to the subject, the stimuli being provlded
by at least one selected stimuli-generating module in the host
controller/processor; (c) subject response means for registering
responses of the subject to the sequential input stimuli and for
relaying the responses to the host controller/processor; ~d) data
entry means for instructing the host controller/processor to
provide the stimuli from the selected stimuli-generating module
in a predetermined sequence; and ~e) and an analysis, storage and
communication means interfaced with the host controller/processor
to carry out the analysis of test data, the archival storage of
recently acquired test data, the comparison with previously
stored data and the reporting of test results.
In a specific embodiment of the apparatus of this invention,
an automated multi-purpose real-time apparatus is provided for
administration of stimuli to a patient, for evaluating perfor-
mance levels of a selected at least one of visual, auditory,
cognitive and attentional capacities of a patient, using a
host/controller processor including memory and mass storage
capabilities for storing data and instructions, -the apparatus
comprising: (a) an operator station means having an input display
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means permitting an operator of the apparatus to select
individual test parameters, individual tests or sequences of
tests; (b) a patient ~tation means having a display means, an
input means fox applying stimuli from a selected test to the
patient, and a response means for the collection of patient
responses to the applied stimuli ana for inputting the responses
to the host controller/processor; (c~ a stimulus generator module
at the operator station for providing the stimuli from a selected
test and also for providing a real-time image generation means;
and (d) a test measurement module, resident in the host con-
troller/processor, for providing a data capture means for cap-
turing patient responses, for providing an update means for
recording patient responses, and for providing a report means for
providing test reports and patient optiMization feedback signals
to the patient station means.
The analysis means should preferably înclude a data
comparison means and a data storage means. The operator control
means should preferably include means to start, to stop and to
restart the test sequence for test optimization. The real-time
image generation means should preferably include an interface
means for interfacing an image storage means to the host con-
troller/processor, most preferably in the form of a video disk
storage device. The host controller/processor should preferably
include interfacing means for inputti.ng electrode sensor input
signals to the host controller/processor. The host controller/
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processor interface means should preferably include an input
means and a display means to enable the operator to provide
parameter selection lnformation to the host controller/processor.
The means for applying stimuli from a selected test should
preferably include both a visual stimulation test means, and an
auditory stimulation test means.
The test measurement module pre~erably also includes an eye
movement monitor means for recording eye position and movements.
The eye movement monitor preferably comprises an infra-red light
source and an infra-red sensitive closed circuit television
camera and automated eye movement data analysis means.
As mentioned above, the means for administering at least one
of visual and auditory stimuli preferably includes both a visual
stimulation test means, and an auditory stimulation test means.
Preferably, the visual stimulatlon test means may include a high
intensity electric light source and a graphics display means for
providing visual and colour stimuli testing signals a-t the
patient station means. Preferably, the auditory stimulation test
means may include an interface means for interfacing an auditory
means with the host computer/processor for providing auditory
stimuli testing signals.
In general terms, the apparatus includes visual and/or
auditory stimuluY generation means, a response acquisition means,
a data display means and host controller/processor means with
memory and mass storage capability. Stimulus generation means
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includes auditory and~or visual ~timulus generation means is used
to present calibrated, predetermined sequences of test stimuli to
the subject/patient under control of the host controller/pro-
cessor. Both test stimuli and test instructions may be presented
using the stimulus generation means. Subject response means are
provided for registering various behaviourial responses from the
subject and for relaying these responses to the host controller/
processor. The apparatus also includes an operator control con-
sole for by which data entry and editing means are provided for
programming the host controller/processor. This provides the
capability for modification of the specifics of individual test
modules and for the assemblage of various selected test modules
in a variety of predetermined sequences. A data analysis and
archiving means is provided for analyzing and storing the results
obtained from the administration of individual tests and test
batteries and for updating a database archive of patient files.
Finally, a reporting and communications means is provided -to
permit the display of various summaries of test results through
reference to the database archive.
In the accompanying drawings,
FIGURE 1 is a block diagram of a computerized, real-time
visual and auditory stimulator and test apparatus according to
one embodiment of the present invention showing its main logic
control components;
FIGURE 2 is an overview of the system block diagram of the
apparatus of EIGURE 1;
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PIGUR~ 3 is a system block diagram of the system development
and training functions of FIGURE 2; and
FIG~RE 4 is ~ system block diagram of the stimuli test
function of FIGURE 2.
Turning first to Figure 1, a block diagram of the
computerized te~t apparatu l2) according to one embodiment of
the present invention is shownO The test apparatus t2~ consists
of a host ccntroller/processor ~4) which is preferably, but is
not necessarily limited to, a microprocessor, a test operator
control station (6) which include~ a display t8) and a keyboard
shown generally as (10) and a patient station (12), which also
includes a display ~14), a keyboard ~9) for entering responses
and for displaying test stimuli and instructions to a patient. A
printer tl9) is connected to the host controller/processor (~)
for providing a hardcopy of a report as required. The stimu-
lation subcomponent (22) provides an interface between the
devices of the patient station ~12) and the hoit controller/pro-
cessor ~4). A storage ~54) i5 connected to the host computer,
the storage (54) including test files, depicted as blocks (70),
(72), (74), (76) and (78). The real-time generation component
(24) provides an interface between the image stage (26) and the
stimulation subcomponent (22). The behaviourial response
monitoring component ~28) provides an interface between the hand
response component (30), the voice response component (32), the
eye response component (34) and the host controller/processor
(4).
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The host controller/processor ~4) provides the automation
capability of the system. It is possible, within the ambit of
this invention, to sequence a number of tests into test batteries
to optimize time and space efficiency in the provision of clini-
cal service and to increase the power of diagnostic procedures.
Through careful design of a number of test
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batteries, such that each one is specific to certain disease
categories or diagnosis requirements, it will be possible to
decrease total "worst case" patient
testing to khat of a single testing session of less than two
hours. ~ence, optimization of the test could be achieved.
Furthermore, a database management facility may be used to permit
comparison of individual test results with normative data from
the database, thereby to enhance the value of the test apparatus
and method of the present invention.
Referring now in more detail to the system block diagram of
Figures 2 and 3, upon starting up, the initializa-tion module (38)
of the processor (4) initializes the system and passes control to
log-on procedure module (40), which provides log-on request at
the display (8) of the operator control station (6) in order to
allow an operator to start the test session. Once the operator
has completed the log-on procedure, the log-on procedure module
(40) requests the operator to select system functions, e.g.
development function (46), operator training function (44) or
test function (42).
The development function (46) allows modifications and/or
enhancements to be added to the system, such that each system
could be customized and optimized according to the requirement.
IE the development function (46) is selected, the log-on
procedure module (40) passes control to the development function
(46) which, in turn, passes control to the system development
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module (4~). The system is then set for modifications and/or
enhancement purposes. ~t the end of such system development, the
system development module (~8) passes control to the end routine
(68) which, in turn, returns the system back to the initialized
stage.
The operator training function (44) provides training
sessions for system operation. Such function is provided by the
training module ~50). Upon termination of the training session,
the training module (50) returns control to the end routine (68)
which sets the system back to the initialized stage.
Referring now -to Figure 4, the test function (42) allows
tests to be performed. Once the test function (42) is selected
;~ by the operator from the operator control station (6) by using
the key~oard (10), the system passes control to the test manual
module ~52) which displays further test selection and patient
requests on the display (8) at the operator control station (6).
Having completed patient information from the keyboard (10), the
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operator can now select either an individual test function (56)
or a battery test function (58).
In either case, the system will present further test
parameter requests to the operator at the display (8) of the
operator control station (6). Thèrefore, the operator can
optimize the administration of the test facility by requesting
certain parameters or by using default values, without
compromising the tests. Furthermore, the system provides
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interru~t capability to the operator so that tests can be quickly
and easily aborted and restarted with the capability to continue
from the stopping point of the test.
If the operator selects the individual test function (56),
the system passes control to the single test administration
module (64) such that the system raquests the operator to select
the type of individual test available in the system. Each of
these tests provides certain specifications of test parameters in
a test file (70) located in storage (54). Each test has a
;10 "query" point where the operator can invoke the default test
parameters contai~ed in the test file t70). Also, each test is
associated with a stimulus graphics file (72), also located in
storage (54). In addition, parameters for patient performance
~` optimization can be provided in test file (70) in order to
provide feedback to the patient regarding test performance.
urthermore, each test is associated with an additional file,
namely, a patient instruction file (74) which provides
information on the display ~14) at the patient station (12) for
the patient to carry out the test.
Once the operator has selected the type of test and has
'~ provided patient data to the patient data file (62) (if he has
selected the single test administration module (64)), or has
passed through the test search module (60), (if he has selected
the battery test (58)), the system passes control to the test
administration module and file generator (66) whereby, based on
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the information in the test file (70), the stimulus module (76)
sets up the proper test sequence by passing control to the
appropriate routine. In the case of a visual test, the
stimulus module (76) passes control to the visual test module
(78) whlch will cause test patterns to be displayed at the
display (14) of the patient station (12) and to provide
instructions to the patient at the display (14) of the patient
station (12). It may also provide audio instructions for visual
tests and/or visual instructions for auditory tests. In the case
of an auditory function test, the stimulus module (76) passes
control to the auditory test module (80), whereby the auditory
test module (80) causes test signals to be generated at
headphones/speakers (36) of the patient station (12). In
addition, the stimulus module (76) communicates with the response
requisition module (84) to monitor the response from the patient.
The response requisition module (84) interfaces ~ith the response
monitoring subcomponent (28) (see Figure 1) which includes hand
response component (30), voice response component (3~) and eye
response component (34). The responses are fed into the
processor (4) and the data are analyzed by the data analysis
module (86). In this way, test results and reports with
appropriate graphics can be provided at the end of the test from
the hardcopy printer (20) or can be displayed at the display (8)
of the station (6) (see Figure 1). Furthermore, results
communicated to the patient could also ~e used to provide
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performance feedback to the patient under test in order to
optimize patient performance.
Finally, on the completion of the testing session, a message
appears on the patient display (14) indicating that the session
is complete. The patient data file is updated with the results
of the analysis by the test database update module (88). A
~ printout of an interim report of the results of the test may ~e
generated by the hardcopy generator module (90) and the system
passes control back to the test administration module (68). The
operator display (8) is set back to the test selection session.
As noted before, instead of selecting individual tests, the
operator can select a test battery. In such a case, control is
~ passed to the test function battery module (58~ such that the
; operator can select a number of tests into the test batteries in
order to optimi2e the use of time and space. Then the system
passes control to the test search module (60) to set up the test
files and parameters. The test search module (60) eventually
passes control to the test administration module and file
generator (56) and the test session a follows similar path to the
20 single test session from then on.
The image/audio data of the test patterns of all the test
sessions are stored in the image storage module (26) which may be
;~ a video disk. It is understood that such device may be
substituted by other devices without affecting the performance of
the system.
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Hence it can be seen that the present invention is capable
of performing all the procedures common to at least one of visual
and auditory tests, as the system provides the facility to set up
the operator and patient instructions by the user.
Thus, it is apparent that, in accordance with broad concepts
of this invention, a computerized test apparatus has been
provided that fully satisfies the objects, aims and advantages
set forth above. It will also be apparent to one skilled in the
art that thè system may be modified to adapt to the operation of
; a different host controller/processor (4), e.g., a minicomputer
or mainframm rompu~mr, or by using diffmrmnt mtoragm ~ans.
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